Modern Pediatrics. Ukraine

The effectiveness of montelukast in the complex treatment of children with seasonal allergic rhinitis caused by sensitization to ragweed and wormwood allergens

Yu.V. Marushko — 2025-03-28

Seasonal persistent allergic rhinitis (AR) is an urgent problem of paediatrics, and its prevalence among the population of European countries is about 16%, increasing every year. Among the allergens that have a significant impact on the development of seasonal AR, sensitization to ragweed and ragweed allergens is of great importance. Basic pharmacotherapy of AR in such patients does not always allow for full control of allergy manifestations, which necessitates the search for adjuvant agents to control AR.

Aim - to evaluate the efficacy of montelukast in children with persistent seasonal AR in case of sensitization to ragweed and wormwood allergens.

Materials and methods. Clinical, anamnestic and laboratory examination of 62 children aged 6 to 12 years with AR and sensitization to ragweed and wormwood was performed in 2023 and 2024. In both years of follow-up, patients received basic therapy according to ARIA recommendations (2022). Montelukast (Glemont), at a dosage of 5 mg daily, was prescribed only in 2024 to patients with the first symptoms of AR.

Results. The duration of clinical manifestations of AR during exacerbations was significantly shorter in patients treated with montelukast. In the examined patients, ‘molecular spreading’ of allergy was observed. When montelukast was used among the patients studied in 2024, complaints of coughing and nasal congestion were significantly less frequent. In patients treated with montelukast, an increase in the level of nitric oxide in the exhaled air (Fraction of exhaled nitric oxide - FeNO) was significantly less frequent.

Conclusions. The addition of montelukast (Glemont) to the treatment regimen for seasonal persistent AR contributes to a significant reduction in the duration of exacerbations by 1.6 times and improves the clinical course of AR. The use of montelukast in the treatment regimen for seasonal AR helps to reduce FeNO levels.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee (LEC) for all participants. Informed consent was obtained from patients (parents of children or their guardians).

There was no conflict of interest.

Prognostic value of the IFABP marker in children with COVID-19

I.Yu. Seriakova — 2025-03-28

Аim - to study the prognostic value of the IFABP marker regarding the occurrence of symptoms of gastrointestinal tract damage and complicated course of COVID-19 in children.

Materials and methods. We conducted a retrospective, cohort, observational study involving children with laboratory-confirmed COVID-19, aged 0 to 18 years. Patients were divided into the main and control groups according to the course of the disease. The main group included 42 patients with complicated COVID-19, and the control group included 46 patients with uncomplicated disease. During the first day of hospitalization, blood serum was collected from 88 patients to determine the level of the IFABP biomarker by enzyme-linked immunosorbent assay. The median with the interquartile interval was determined. To determine the difference in the indicators of the compared groups, the parametric Student's t-test, nonparametric Mann-Whitney and Chi-square tests were used. The Spearman rank correlation test was used to assess the relationship. An operating characteristic curve was constructed and the optimal threshold value of the marker was calculated using the Youden Index calculation method.

Results. According to calculations, in patients of the control group, IFABP was observed at a level of 15.1±3.1 ng/ml, while in children of the main group the indicator was higher, amounting to 21.7±5.5 ng/ml. When conducting a study of the correlation of the IFABP biomarker with gastrointestinal symptoms and complicated course, a correlation relationship was found. According to the results of constructing the ROC curve, the optimal threshold value of the IFABP marker for predicting the risk of developing gastrointestinal symptoms in children with COVID-19 is 29.758 ng/ml. The optimal threshold value of the IFABP marker for predicting the risk of developing a complicated course of COVID-19 in children is 30.132 ng/ml.

Conclusions. The IFABP marker has prognostic value for the occurrence of gastrointestinal symptoms and complicated course of COVID-19 in children. The optimal threshold value of the IFABP marker for predicting the risk of developing gastrointestinal symptoms and complicated course of COVID-19 in children is 29.758 ng/ml and 30.132 ng/ml, respectively.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from patients.

The authors declare no conflict of interest.

Associative relationships of macro- and micronutrient levels in children with atopic dermatitis on BLW complementary feeding

K.I. Tarshyna — 2025-03-28

Baby-led weaning (BLW) is a modern complementary feeding method in which the child independently manages the process of eating solid foods. Despite the growing popularity of BLW, there remain debates regarding whether infants consume adequate amounts of age-appropriate macro- and micronutrients, meet the energy needs of their growing bodies, and the potential risks of developing food allergies, particularly in children with manifestations of atopic dermatitis (AD).

Aim - to investigate the potential associations between levels of iron, calcium, total protein metabolism, and the manifestations of AD in infants on BLW complementary feeding.

Materials and methods. The study included 90 children who started BLW complementary feeding at six months of age. They were divided into three groups of 30 children each: the Group 1 - children on BLW with clinical manifestations of AD, the Group 2 - healthy children on BLW with a complicated family history of atopy, the Group 3 - healthy children on BLW without a complicated family history of atopy. The manifestations and severity of AD were evaluated using the Hanifin and Rajka criteria and the SCORAD index. Biological material was analyzed twice: before starting complementary feeding and six months after its introduction.

Results. In children with AD and those predisposed to atopy, a significant decrease in calcium and iron levels was observed after six months of BLW complementary feeding. Overall, there was a 10% increase in the prevalence of AD manifestations among the studied groups. A one-way analysis of variance did not reveal a significant association between iron levels and the presence/severity of AD. However, a significant moderate negative correlation was identified between calcium levels and the SCORAD severity score after six months of BLW complementary feeding.

Conclusions. The findings demonstrated associative relationships between micronutrient levels and AD manifestations in children on BLW complementary feeding. Confirmation of these results through further studies with larger cohorts of children on BLW could highlight the need for dietary adjustments, particularly for children with AD manifestations or a family history of atopy.

There was no conflict of interest.

Sepsis in children with community-acquired pneumonia: clinical and laboratory features

V.M. Dudnyk — 2025-03-28

Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response to infection. Despite a decline in mortality among children under the age of five, the fatality rate in older children continues to rise. Sepsis associated with community-acquired pneumonia remains one of the leading causes of hospitalization in pediatric practice.

Aim - to identify the clinical and laboratory features of sepsis in children with community-acquired pneumonia.

Materials and methods. The study included 389 children aged 5-18 years, divided into retrospective (n=214), prospective (n=135), and control (n=40) groups. Disease severity was assessed using the Phoenix scale, which evaluates the function of four organ systems. Statistical analysis was performed using Student’s t-test and Fisher’s exact test (p<0.05).

Results. Children with pneumonia showed significant organ dysfunction: reduced PaO₂/FiO₂, elevated lactate, coagulation activation, and hypotension (p<0.001). In the retrospective group, metabolic disturbances were also reflected by higher lactate and altered hemodynamics. Among patients with ≥4 Phoenix points, severe pneumonia was observed in 80-100% of cases. Increases in C-reactive protein (CRP), leukocytes, erythrocyte sedimentation rate (ESR), nterleukin-1 (IL-1), and interleukin-6 (IL-6) levels correlated directly with illness severity. Тhe incidence of complications-including pleuritis, atelectasis, and need for mechanical ventilation-rose with higher Phoenix scores. In severe cases, hospital stays were 1.4 times longer, while the proportion discharged without complications was 2.5 times lower compared to mild cases.

Conclusions. In children with community-acquired pneumonia, sepsis is accompanied by pronounced organ dysfunction and a systemic inflammatory response. The Phoenix scale is an effective tool for early identification of severe forms of disease, assessment of complication risk, and selection of appropriate treatment strategies.

The authors declare no conflict of interest.

Differentiated approach to the prevention and management to metabolically associated fatty liver disease in overweight and obese children

O.O. Starets — 2025-03-28

Obesity is one of the most important public health issues worldwide, affecting people of all age groups.

Aim - to assess the impact of a differentiated approach to the prevention and management of metabolic-associated fatty liver disease (MAFLD) in overweight and obese children, taking into account the presence of vitamin D deficiency.

Materials and methods. The study included 298 overweight and obese children aged 6 to 16 years. A clinical and laboratory examination was conducted. 45 children with MAFLD and vitamin D deficiency were selected and included into the main group. The factor analysis of vitamin D deficiency on the occurrence and course of MAFLD was conducted. Counseling was provided. Vitamin D supplementation was recommended to children with deficiency. Treatment results were assessed based on liver function markers, metabolic parameters, and vitamin D levels.

Results. The frequency of MAFLD in the study cohort reached 27%, vitamin D deficiency was detected in 37% of children. MAFLD and insufficient serum vitamin D levels were identified in 15% of children. Intrauterine growth retardation, excessive consumption of easily digestible carbohydrates and trans fats, sedentary lifestyle and lack of exercise, obesity, prehypertension and prediabetes and specific changes in liver ultrasound as factors associated with MAFLD are likely to occur more often in combination with vitamin D deficiency. Children from main group got supplementation with vitamin D at a dose of 2000 IU for 3 months. Children with overweight/obesity and MAFLD had shown good dynamics of laboratory indicators of alanineaminotransferase level, carbohydrate and lipid profiles. At the same time, obese children had a lower average level of vitamin D (29.3±5.0 ng/l) in blood serum after treatment than overweight children (40.8±4.6 ng/l).

Conclusions. Vitamin D supplementation in children with MAFLD in combination with a standard treatment regimen significantly improved liver function, lipid and carbohydrate metabolism.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local institutional ethics committee. Informed consent was obtained from the patients (or from the parents or legal guardians of the children) prior to participation.

The authors declare no conflict of interest.

Method of determining the amount of spine deformation in adolescent idiopathic scoliosis by angle measurement

O.F. Tkach — 2025-03-28

In the structure of orthopedic pathology among children, the leading place is occupied by adolescent idiopathic scoliosis, the progressive nature of which leads to scoliotic disease and early disability. 80% of all types of scoliosis are idiopathic and 80% of them occur in adolescents, with the onset of pathology at the age of about 10 years.

Аim - determination of the main diagnostic approaches in identifying the features of clinical, functional and orthopedic manifestations of adolescent idiopathic scoliosis.

Materials and methods. The study included 30 patients (12 boys and 18 girls) aged 10 to 17 years with subjective clinical signs of adolescent idiopathic scoliosis of varying severity. The results of the examination of all patients were taken into account by us directly at the initial request for medical help, both subjective and objective methods.

Results. In order to minimize possible errors, we suggest determining the amount of deviation of the spine axis by measuring with a protractor the angle between the horizontal line that runs along the surface of the muscle shaft and goes to the spinous process of the vertebra and the line that runs perpendicular to the above-described line through the most outwardly protruding the point of the spinous process of the vertebra.

Conclusions. The proposed method makes it possible to monitor the development of the spine under the control of treatment results an unlimited number of times, allowing to determine the effectiveness of the chosen strategy of rehabilitation measures, to carry out an objective quantitative analysis of the expressiveness of the compensatory and restorative process with a certain prediction of possible results and consequences of the pathological process.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child's parents was obtained for the research.

The authors declare no conflict of interest.

The relationship between the reform of the nutrition system in preschool and school institutions and the health of children of different age groups

N.P. Chornopyshchuk — 2025-03-28

Nutrition plays an important role in children's development, health, academic performance, and productivity.

Aim - to investigate how changes in the diet after the reform of the nutrition system in preschool and school institutions affect the health of children of different age groups.

Materials and methods. The study involved 216 surveyed parents who provided information about 309 preschool and/or school-aged children, divided into two groups: the Group 1 - children under 6 years old (n=64); the Group 2 - children over 6 years old (n=245). The following research methods were used: analysis of medical literature (PubMed, UpToDate), questionnaires, and statistical methods.

Results. After the implementation of the nutrition reform in educational institutions, the most noticeable and significant changes were a reduction in the amount of salt and sugar in meals, as well as an increase in dietary fiber. Preschool-aged children were significantly more likely to follow healthy eating habits at home compared to school-aged children (by 1.3 times). Overall, 52% of children received support from at least one parent regarding healthy eating outside educational institutions, with the Group 1 receiving such support more often, although the difference was not statistically significant. The transition to the new diet was easier for younger children (by 1.4 times). After the reform, the most notable health improvements in the Group 1 included a 1.6-fold decrease in vomiting and a 1.3-fold reduction in symptoms of constipation/diarrhea, while in the Group 2, there was a 1.5-fold decrease in heartburn and a 1.2-fold reduction in abdominal pain.

Conclusions. The reform of the nutrition system in preschool and school educational institutions had a positive impact on children's health, especially when supported by the family and accompanied by adherence to healthy eating at home.

The authors declare no conflict of interest.

Analysis of the amount of endothelin-1 in children with haemostatic disorders induced by herpetic infections depending on severity and activity of the disease

V.M. Dudnyk — 2025-03-28

In herpes infections, the virus actively interacts with the immune system, leading to an inflammatory response. This reaction can stimulate the formation of endothelin-1, which in turn can increase inflammation and lead to microcirculatory disorders, increased inflammation and increased risk of complications.

Aim - to analyse the content of endothelin-1 in children with haemostatic disorders induced by herpes infections, depending on the severity and activity of the disease.

Materials and methods. 100 children aged 0-18 years with haemostatic disorders induced by herpetic infections were examined at the onco-haematological department of the Vinnytsia Regional Children's Clinical Hospital of the Vinnytsia Regional Council. For comparison purposes, 40 practically healthy children were examined. In addition to general clinical examinations, all subjects underwent C-reactive protein, interleukin (IL)-1 and IL-6, endothelin-1, and polymerase chain reaction for Herpes Simplex (HSV) 1, HSV2, Cytomegalovirus, Epstein-Barr virus, Human Herpesvirus (HHV) 6, HHV 7 and HHV 8.

Results. The level of endothelin-1 in children with haemostatic disorders induced by herpes infection was significantly higher than in healthy children. It was also noted that endothelin-1 levels were significantly (p≤0.05) higher in patients with vasopathy compared to those with thrombocytopenia and thrombocytosis. It was found that children with HSV 1 and 2 had significantly higher levels of endothelin-1 in the range (40.81-64.40)% compared with other agents. The presence of a positive moderate correlation between certain indicators of inflammatory process activity and endothelin-1 levels was revealed.

Conclusions. Determination of endothelin-1 level may be one of the indicators of severity and activity of the pathological process, as well as a future target in the treatment and prevention of haemostatic disorders induced by herpetic infections in children.

The authors declare no conflict of interest.

Analysis of the effectiveness of botulinum toxin type A procurement and access to tiered injections for children with spastic cerebral palsy in Ukraine

O.O. Wolf — 2025-03-28

The relevance of the study is determined by global changes in medicine, where an important request is to find effective methods of treatment of pediatric diseases, in particular cerebral palsy (CP), which is the main cause of pediatric disability. According to the World Health Organization, CP is common in 2-5 cases per 1,000 children, and 75% of them have a spastic form, which requires a special approach to treatment. Injections of botulinum toxin type A are one of the most effective methods of reducing spasticity. However, there are problems with access to these drugs in Ukraine, which emphasizes the need to analyze their supply and use in regions.

The aim of the study was to analyze the provision, availability, and use of medicines for the treatment of a spastic form of CP in Kyiv, Zhytomyr, Kharkiv, Dnipro, Zaporizhzhia regions and the city of Kyiv.

Materials and methods. The study covered the monitoring of botulinum toxin type A supply for the period 2019-2023. It consisted of two parts: data were obtained from open databases and official websites, including the Ministry of Health of Ukraine and medical institutions. To assess the drugs prescribed to patients and the level of satisfaction with the supply, surveys and interviews were conducted with patients and healthcare professionals. The survey covered 530 patients with a response rate of over 90%.

Results. The study showed that 40% of respondents complained about the lack of free medicines, and 20% noted their absence in medical facilities. A decrease in delays in supply and problems with treatment interruption were noted by 5% of respondents. Successful public procurement related to the increase in the volume of medicines procured has reduced costs during tenders.

Conclusions. The main factors limiting the provision of medicines for the treatment of children with CP are insufficient funding and an inefficient procurement system in Ukraine.

The authors declare no conflict of interest.

Enterosorbents in modern medicine: mechanisms of action, effectiveness and clinical application

О.S. Nyankovska — 2025-03-28

The use of enterosorbents is widespread in modern medical practice — both in emergency care for acute intoxications and in the treatment of chronic diseases, including disorders of the digestive and urinary systems, helminthiases, and allergic conditions.

Aim - to analyze current scientific data on enterosorbents; assess their effectiveness and safety, and provide recommendations on the choice of drugs for clinical use.

Deterioration of the ecological situation and increasing environmental pollution contribute to the accumulation of exotoxins in the human body, overwhelming natural detoxification systems and leading to increased morbidity and mortality. Therefore, the search for effective and safe preparations with high sorption capacity and selectivity remains highly relevant. The administration of enterosorbents should take into account their efficacy, safety, and pharmacological properties. This article reviews current scientific data on the mechanisms of action of enterosorbents, their clinical application, efficacy, and criteria for selecting an appropriate preparation for medical use.

Conclusions. The most effective today are silicon-containing enterosorbents of the IV generation based on highly dispersed silicon dioxide, which have high sorption activity, demonstrate selectivity of action - bind toxins without affecting vitamins and trace elements, have cytoprotective and bacteriostatic effects, are completely excreted from the body, and are approved for use in pregnant women, breastfeeding women, and children.

The authors declare no conflict of interest.

The application of azithromycin solution in the treatment of inflammatory eye diseases in the practice of pediatricians and general practitioners of family medicine (literature review)

Yu.V. Marushko — 2025-03-28

The presented review is devoted to modern views on the mechanisms of development, diagnosis, prevention, and treatment of inflammatory eye diseases in children.

The aim is the systematization of pediatric patients’ management data with inflammatory eye diseases at the outpatient stage of medical care by pediatricians and general practitioners/family medicine physicians.

Most cases of inflammation of the eye surface in children are caused by bacterial conjunctivitis. Conjunctivitis in newborns occupies a special place, that is caused by the specificity of pathogens in the postnatal period. The article highlights the dynamics and duration of neonatal conjunctivitis, clinical manifestations and consequences depending on the pathogen, global data on the spread of the disease, and a comparison of the effectiveness of different treatment approaches. The main symptoms of conjunctivitis in children are covered thoroughly, in particular, the duration of the disease, the involvement of one or both eyes, the nature of the discharge from the eye (eyes), and accompanying signs that may help in the determination of the etiology. The article discusses approaches to the differential diagnosis of conjunctivitis, as well as the causes of eye hyperemia as the main clinical symptom. To unify the management of pediatric patients with bacterial conjunctivitis at the outpatient stage of medical care and based on evidence-based recommendations, the authors proposed a diagnostic and treatment algorithm for a child presenting eye redness. The pharmacological aspects of the application of azithromycin are considered. Research data on the activity and effectiveness of 1.5% aqueous solution of azithromycin in the form of eye drops and an aqueous solution of tobramycin are presented.

The authors made a conclusion that it is advisable to apply a 1.5% aqueous solution of azithromycin in the form of eye drops for the treatment of bacterial conjunctivitis, dacryocystitis, and chalazion in children.

The authors declare no conflict of interest.

Effectiveness and safety of vitamin D use in pediatric practice

T.V. Hyshchak — 2025-03-28

The review article presents data from modern studies confirming the multifaceted effect of vitamin D in the human body.

Aim - to summarize the scientific literature regarding the efficacy and safety of vitamin D use in pediatric practice.

It has been proven that receptors for the vitamin are present in most organs and tissues of the body. This confirms the importance of vitamin D not only in the processes of bone formation, but also in many of its extra-skeletal effects. Vitamin D affects the modulation of cell growth, neuromuscular conduction, has an anti-inflammatory effect, and is also an important stimulator of innate immunity due to the synthesis of antimicrobial peptides. Many studies have shown that vitamin D deficiency is characteristic of most children with respiratory infections and allergic diseases. Good preventive and therapeutic efficacy of vitamin D in acute and recurrent respiratory diseases, bronchial asthma, atopic dermatitis, allergic rhinitis and other pathological conditions in children and good tolerability of vitamin D have been revealed. To obtain the effect of vitamin D use, serum 25(OH)D concentrations should be maintained above 30-40 ng/ml (75-100 nmol/l).

The use of Detrimax® is considered beneficial due to its safety profile (absence of harmful additives such as benzyl alcohol, emulsifiers, stabilizing agents, etc.); high bioavailability (thanks to its oil-based formulation); user convenience (pump dispenser and small capsule size); and a wide dosage range, which is important for individualized treatment in clinical settings.

The authors declare no conflict of interest.

Sensitive skin syndrome in children

O.M. Mochulska — 2025-03-28

Sensitive skin syndrome in children is an extremely relevant problem in our time, which is being intensively studied all over the world. According to known scientific data, more than half of the world's population has sensitive skin, which significantly worsens the quality of life of patients.

Aim - to increase awareness about sensitive skin syndrome in children, classification, modern diagnostic methods, clinical features and treatment of sensitive skin in children.

Sensitive skin syndrome is a combination of subjective (pain, hyperesthesia, tingling, burning, itching, tightness) and objective clinical symptoms (erythema, reactive transient hyperemia, dryness, peeling, increased skin pattern, tendency to telangiectasia). Sensitive skin syndrome in children can be characterized as reduced resistance or increased reactivity of the skin in response to common exogenous and/or endogenous factors that cannot be considered as common irritants. The formation of sensitive skin syndrome in children is influenced by many factors: age, gender, skin phototype, structural changes in the skin caused by genetic and constitutional factors, hormones, physiological irritants, weather, climatic and environmental factors, lifestyle, and concomitant dermatological diseases. The variety of known modern classifications of sensitive skin types reflects the lack of a unified position among dermatologists on this issue. A significant number of invasive and non-invasive tests have been proposed by scientists to assess and predict sensitive skin in children. Modern recommendations for caring for sensitive skin in children are focused on the following areas: avoiding provoking irritants, restoring the skin barrier, regulating the epidermal microbiome, and calming neuroinflammation.

Conclusions. Sensitive skin syndrome in children is a universal phenomenon in a modernized society with widespread use of cosmetics and personal care products. Knowledge of possible exogenous and endogenous irritants to sensitive skin will allow for the targeted development of personalized recommendations for the care of sensitive skin in children. Screening and timely diagnostic, proper care, and treatment of sensitive skin syndrome in children can improve health and enhance quality of life.

The authors declare no conflict of interest.

Approaches to the management of children with lactase deficiency

S.I. Yesipova — 2025-03-28

The article presents review data and results of the authors' own research on modern approaches to the problem of lactase deficiency (LD).

Аim - to summarize the literature on modern ideas about the terminology, diagnosis and treatment of LD in children.

According to international sources, LD is divided into primary and secondary and can be observed both in childhood and adulthood, which depends on the level of lactase activity. With insufficient enzymatic activity and the use of products containing lactose, such individuals experience various gastrointestinal symptoms. The main approach to the treatment of LD is to limit or completely exclude lactose from the diet until the symptoms disappear. The use of enzyme preparations (lactase) and the use of lactose-free alternative products are also recommended. But cow's milk is an important source of calcium, vitamins and minerals and its complete elimination from the diet without proper compensation can lead to disorders of mineral metabolism, in particular osteopenia and osteoporosis. Therefore, competent diet therapy is a key element in the management of patients with LD. Currently, there is growing interest in the use of lactose-free milk among both children and adults suffering from this pathology. During the study, a dynamic assessment of clinical symptoms was performed in 20 children aged 3-15 years with manifestations of secondary LD against the background of the use of lactose-free milk "Kazkove". A positive effect on the dynamics of clinical symptoms of secondary lactase deficiency was revealed.

The authors declare that there is no conflict of interest.

Anatomical-functional and pathological aspects of the mechanisms of interaction of the mother - placenta - fetus system

T.V. Pankiv — 2025-03-28

In recent decades, there has been a significant breakthrough in studying the embryonic and fetal periods of human development. This achievement was made possible by introducing the latest technologies, such as ultrasound scanners, computed tomography scanners, and genetic analysis methods. The expanded capabilities allow for a more detailed study of fetal development, detecting abnormalities in the formation of organs and timely response to possible pathologies, which opens up new horizons for fetal surgery and perinatal medicine.

The aim of the study was to examine modern sources of literature and systematize disparate and insufficiently organized theoretical information on the mechanisms of integration of the functional system "mother - placenta - fetus", the boundaries of the external environment surrounding the fetus, and also to assess the prospects for treating the fetus as a full-fledged patient.

According to modern ideas, the first anatomical and functional complex in the "mother - fetus" system is formed between the vessels of the endometrium and the blastocyst, in the creation of which progesterone plays a key role. In the processes of implantation and placentation, synchronization between the preparation of the blastocyst and the endometrium is critically important. Complete integration of the maternal and fetal organisms becomes possible only after the formation of the placenta.

The Amsterdam Working Group divides pathological conditions of the placenta into four main categories: maternal vasculopathy of pregnancy, fetal vasculopathy, infections, and inflammations, including chorioamnionitis and placentitis, and other pathological conditions, such as placental abnormalities, chronic inflammatory processes or implantation disorders.

The authors declare no conflict of interest.

Post-COVID-19 health in children: from understanding pathogenesis to effective rehabilitation

Yu.V. Marushko — 2025-03-28

COVID-19 is a significant challenge for pediatrics, as it negatively affects the health of children, causing the development of post-COVID-19 syndrome. It is important not only to eliminate acute symptoms, but also to develop long-term rehabilitation programs that take into account all aspects of the physical and psycho-emotional recovery of patients.

Aim - to summarize and analyze modern scientific data presented in publications in the PubMed, Scopus, Web of Science databases, as well as in international and domestic clinical guidelines and guidelines over the past 5 years, regarding the pathogenesis of post-COVID-19 syndrome in children and to substantiate effective approaches to rehabilitation aimed at restoring respiratory system functions and improving the overall functional status of pediatric patients.

Analysis of scientific sources and clinical guidelines over recent years allows us to identify key aspects of the pathogenesis of post-COVID-19 syndrome in children. To date, a number of mechanisms have been studied that underlie prolonged symptoms in children after COVID-19. Immune disorders that occur after an infection can contribute to the development of chronic inflammatory processes that cause prolonged symptoms. Given these factors, the development of post-COVID-19 syndrome in children necessitates a comprehensive approach to diagnosis, treatment, and rehabilitation. In particular, an important component is physical therapy, which includes exercises to improve respiratory function, restore endurance and strengthen muscles. In addition, psycho-emotional support is important to overcome anxiety and stress that may arise as a result of the disease and prolonged recovery.

Conclusions. Rehabilitation after COVID-19 is an important stage of recovery for patients with impaired lung function, aimed at improving respiratory function and the patient's overall condition. A multidisciplinary approach and individualization of treatment are key to achieving successful results in restoring body functions. Further research in this area will help improve rehabilitation methods and develop optimal strategies for patients with post-COVID-19 disorders.

The authors declare no conflict of interest.

Peripheral facial nerve palsy in a child with reactivated Epstein-Barr virus infection and human herpesvirus 6 infection: a case report

H.B. Mateiko — 2025-03-28

Neurological complications of Epstein-Barr virus (EBV) infection include a wide range of diseases with the involvement of both central and peripheral nervous systems. Peripheral facial nerve palsy is the most common cranial nerve damage and herpesviruses play an important role in its etiology. We present a clinical case of peripheral facial nerve palsy associated with reactivation of EBV infection and human herpesvirus type 6 (HHV-6) infection in a 16-year-old boy.

The aim of the study is to describe a clinical case of peripheral facial nerve palsy in a child with associated herpesvirus infection.

Clinical case. A 16-year-old boy was hospitalized in the neurology department with complaints of numbness of the tongue, lips, enlargement of the submandibular lymph nodes and parotid salivary glands, facial asymmetry, dry eyes, and mild redness of the sclera. The submandibular lymph nodes were enlarged to 2.5 cm in diameter, tender to palpation, mobile, and not adherent to the surrounding tissues. The parotid and sublingual salivary glands are enlarged, dense, and painful on palpation. Pathological neurological symptoms were detected: sagging eyebrows, lagophthalmos on the left side, nasolabial folds S˂D, and drooping of the left corner of the mouth. It was performed: DNA HHV-6 - 1.03×10⁴ copies and DNA EBV - 7.65×10⁵ copies were detected. Immune enzyme analysis of serum revealed positive anti-VCA IgG, anti-EA IgG, and anti-EBNA IgG. Antiviral treatment was prescribed - valganciclovir and recombinant human interferon alpha-2b. On the background of antiviral therapy from week 3, a noticeable regression of neurological symptoms was observed, and by week 5, the size of the salivary glands had normalized.

Conclusions. In the case of neuropathy, EBV and its association with other herpesviruses, particularly HHV-6, should be considered as a possible etiologic factor. Tests to detect these pathogens should be included in the list of workups for such patients. In addition to the characteristic lymphadenopathy, sialoadenitis is one of the important clinical markers of replicative forms of infections caused by EBV and HHV-6.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent was obtained from the patient and parents.

The authors declare no conflict of interest.

Double challenge: β-thalassaemia caused by a heterozygous pathogenic variant in the HBV gene (c.315+1G>A) and ulcerative colitis in a 12-year-old girl (a rare clinical case)

O.I. Dorosh — 2025-03-28

Ulcerative colitis (UC) is a chronic inflammatory disease of the intestinal tract with an unknown etiology, characterized by a recurrent course and complications such as anaemia due to iron deficiency, vitamin B₁₂ or B₉ deficiencies, or autoimmune haemolysis. β-thalassaemia, an inherited disorder caused by changes in the structure of the β-globin gene (HBB) on chromosome 11, leads to impaired β-chain synthesis in haemoglobin and anaemia of varying severity. The coexistence of these conditions complicates diagnosis and treatment, as symptoms may interact or exacerbate each other. Anaemia in β-thalassaemia can worsen due to chronic blood loss or impaired absorption associated with UC. While UC has occasionally been reported with sickle cell anaemia, its coexistence with β-thalassaemia remains undocumented in the literature.

Aim - to describe a clinical case of a rare combination of UC and β-thalassaemia in a 12-year-old girl.

Clinical case. We report a unique case of UC associated with the NOD2-mutation with extraintestinal manifestations and β-thalassaemia in a 12-year-old girl, caused by a pathogenic heterozygous HBВ mutation (c.315+1G>A) (rs33945777). The patient presented with vomiting, diarrhoea with occasional blood, tenesmus, headaches, weight loss, and hepatosplenomegaly. Hypochromic microcytic anaemia was initially misinterpreted as iron deficiency. UC was diagnosed through clinical signs, colonoscopy, imaging, elevated IgG proteinase 3 antibodies, histopathological findings. β-thalassaemia was confirmed by Next Generation Sequencing (NGS) and Hb-electrophoresis.

Conclusions. The coexistence of UC and β-thalassaemia in a 12-year-old girl represents a rare and complex case. Each of these pathological conditions requires a special multidisciplinary approach to treatment, taking into account the specifics of the disease.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Challenges in diagnosing IBD-like intestinal lesions in young children

O.G. Shadrin — 2025-03-28

Among inflammatory bowel diseases (IBD) with very early onset, particularly in children under two years of age (Infantile Form IBD), monogenic IBD-like disorders account for a significant proportion — up to 35%. Most of these conditions are associated with congenital immunodeficiencies. Our research also suggests a possible link between IBD-like intestinal mucosal lesions and certain congenital gastrointestinal malformations (such as neuropathy and myopathy) as well as severe viral infections, including COVID-19.

Aim - using the example of a clinical case, to show the phenotypic features, difficulties of diagnosis and treatment of CKD-like diseases in young children.

This article discusses the characteristics of IBD-like intestinal lesions associated with other diseases in young children, based on an examination of 10 patients. Among them, six had primary immunodeficiency (including three with genetically confirmed monogenic immune defects), two had congenital gastrointestinal malformations (neuro-muscular dysplasia and primary ileocecal valve insufficiency), and two had a history of virus-identified coronavirus infection (COVID-19) - post-COVID syndrome. Additionally, we describe a clinical case of an IBD-like (Crohn’s disease-like) intestinal lesion in the context of a genetic predisposition caused by a pathogenic NOD2 mutation.

Conclusions. IBD-like intestinal lesions in young children, particularly in monogenic IBD-like diseases, almost always present with a phenotype similar to classic IBD. Therefore, the diagnosis and management of very early-onset IBD, especially in infantile-onset cases, require a personalized approach. This includes the involvement of a multidisciplinary team of specialists, comprehensive immunological assessment, and a careful, individualized treatment strategy for young children presenting with an IBD-like phenotype.

The study adhered to the Helsinki Declaration principle.

Authors report no conflicts of interest.

Surgical treatment and forensic medical assessment: a clinical case of iatrogenic tracheal injury in a child

E.O. Rudenko — 2025-03-28

Medical errors, particularly in pediatrics, are a significant issue that can lead to serious consequences for children's health. The increased vulnerability of children to complications during medical procedures requires highly qualified healthcare professionals and adherence to treatment protocols. Forensic medical analysis is an essential tool for evaluating substandard care and determining the causes of injuries, especially in cases of tracheal injury during medical procedures.

The aim of the study is to present a clinical case of iatrogenic tracheal injury in a child as a result of dental care with subsequent forensic medical analysis.

Clinical case. This case describes a tracheal injury in a 3-year-old child during dental treatment under general anesthesia. After intubation, the child developed subcutaneous emphysema, pneumothorax, and pneumomediastinum, suggesting a possible tracheal rupture. Clinical diagnostics, including computed tomography, confirmed a defect in the tracheal wall. Emergency surgery was performed to repair the tracheal defect, ensuring complete recovery of tracheal function and the patient’s recovery.

Conclusions. Tracheal injuries in children are rare but serious complications that require immediate diagnosis and treatment. An important cause of such injuries is improper intubation technique. A thorough evaluation of clinical symptoms, along with radiological and endoscopic examinations, enables the timely detection of injuries, allowing for the necessary surgical intervention. Forensic medical analysis confirms that such injuries constitute grievous bodily injuries caused by deficiencies in medical care delivery.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the parents of the children prior to participation.

The authors declare no conflict of interest.